Case for Induction of Labour in Treatment of Haemolytic Disease of the Newborn

Rh Antibody Titres and Fœtal Wastage

“…In these 160 Rh-incompatible pregnancies there was a total foetal wastage of 11 3%. This compares with the 12 8 % of Kelsall et al (1958) when induction was based on antibody titres alone and the 12 2% of Tovey & Valaes (1959) in which induction based on antibody titres was used in 'some cases'. Without any induction at all Walker & Murray (1954) had a total feetal wastage of 14% for the years 1952-53. In the present series, however, it was certainly possible to confirm that high Coombs antibody titres (1/40 or more) were associated with low cord hemoglobins, need for exchange transfusion and a high foetal wastage.…”

“…The exact place for induction of labour in the management of rhesus incompatibility is not yet clear. It has been suggested (Kelsall et al 1958, Tovey & Valaes 1959 that Coombs antibody titres are a reliable index of whether the feetus is affected or not and that a high titre will even indicate that it is so severely affected that induction is indicated.…”

Haemolytic Disease of the Newborn

“…The two most important factors to consider are the history of previous pregnancies and the titre of antibodies in the mother's blood. There is some conflict of opinion as to the reliability of antibody levels, but Tovey and Valaes (1959) and Kelsall, Vos and Kirk (1958) have shown that the indirect antiglobulin test (indirect Coombs' test) may be of value in foretelling whether stillbirth is likely to occur. This is the crux of the matter from a practical point of view, for if a stillbirth is not anticipated the pregnancy should be left to go to term.…”